Health Reform May Help the “Duals” on both Medicare and Medicaid
February 22, 2010 - Reports & Studies
Some of the most vulnerable people needing long-term services and supports are the nine million Americans covered by both Medicare – the program for those over 65 and the disabled of all ages - and Medicaid, the health program for income individual. They are “among the “poorest, sickest, and highest cost people covered by both programs,” according to an August, 2009 report by the Kaiser Family Foundation, titled “Health Reform Opportunities: Improving Policy for Dual Eligible.”
Dual-eligible’s’ have all their deductibles and co-pays for Medicare covered by Medicaid. However, while they are protected financially, the report finds that “Navigating two programs with different program rules and financing incentives is complex for beneficiaries and providers, complicates care coordination, and can result in cost-shifting between the two programs.” For example, Medicare pays for a 100-day stay in a skilled nursing after hospitalization, but Medicaid pays for most other long-term care.
After the 100 days have run out, skilled nursing facilities have a financial incentive to allow their patients to be re-hospitalized to allow the clock to restart, because Medicare pays more than Medicaid. The report notes, “Dual eligibles account for nearly half of all Medicaid spending, limiting the ability of states to fund other pressing priorities.” Targeting this population and improving their health will also pay large dividends in terms of dollars saved.